Details

PatientInfo


Is child enrolled in school
Intervention plan
Consanguinity
Yes
Neck holding
Food preferences
HR
Neuropsychiatric condition
Place of Birth
Hospitalization
Tactile
PatientId
8c647446-4359-46db-b52c-ac80cc702489
FollowUpId
00000000-0000-0000-0000-000000000000
Child's Name
Abc
Age
26 Days
Gender
Female
DOB
2026-01-02
Mother’s age (years)
Mother’s education
10th
Mother’s occupation
Homemaker
Father’s age (years)
Father’s education
10th
Father’s occupation
Type of family
Number of family members
Number of siblings
Details of siblings (Age and sex)
Address
Contact
1234556
Referred By
Informant
Chief concerns
Poor feeding
Duration of symptoms
Concerns noticed by school (if any)
Strengths of child
Eye contact
Poor
Interaction
Quality of Interaction
avoids
Repetitive behaviors (RRBs)
If yes- Details
Patterned behavior or activities
If yes- Details
Others
Details:
Impression
Hopes from the consultation

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